Temporal profile of pneumonia after stroke

Jeroen C. de Jonge*, Diederik van de Beek, Patrick Lyden, Marian C. Brady, Philip M. Bath, H. Bart van der Worp

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND AND PURPOSE. The occurrence of pneumonia after stroke is associated with a higher risk of poor outcome or death. We assessed the temporal profile of pneumonia after stroke and its association with poor outcome at several time points to identify the most optimal period for testing pneumonia prevention strategies.

METHODS. We analyzed individual patient data stored in the Virtual International Stroke Trials Archive (VISTA) from randomized acute stroke trials with an inclusion window up to 24 hours after stroke onset and assessed the occurrence of pneumonia in the first 90 days after stroke. Adjusted odds ratios and hazard ratios were calculated for the association between pneumonia and poor outcome and death by means of logistic and Cox proportional hazard regression, respectively, at different times of follow-up.

RESULTS. Of 10.821 patients, 1017 (9.4%) had a total of 1076 pneumonias. 689 (64.0%) pneumonias occurred in the first week after stroke. The peak incidence was on the 3rd day and the median time of onset was 4.0 days after stroke (IQR, 2-12). The presence of a pneumonia was associated with an increased risk of poor outcome (aOR 4.8, 95%-CI 3.8-6.1) or death (aHR 4.1, 95%-CI 3.7-4.6). These associations were present throughout the 90 days of follow-up.

CONCLUSIONS. Two out of three pneumonias in the first three months after stroke occur in the first week, with a peak incidence on the third day. The most optimal period to assess pneumonia prevention strategies is the first four days after stroke. However, pneumonia occurring later was also associated with poor functional outcome or death.
Original languageEnglish
Number of pages8
JournalStroke
Early online date14 Sep 2021
DOIs
Publication statusE-pub ahead of print - 14 Sep 2021

Keywords

  • stroke
  • pneumonia
  • death

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